Friday, August 7, 2009

Caught with our pants down by H1N1

I am still on vacation and my brain is too mushy to do a good new post. So, am recycling an old one. By the way, I modeled the potential number of respiratory failures we can expect in association with this winter's flu season, and now I am more sure than ever that we may be in deep doo-doo. This is made even more relevant by the story in the WaPo yesterday discussing the challenges of the vaccine development and distribution.

Got an e-mail today from a Bloomberg reporter asking about my thoughts on the state of US preparedness for H1N1. Specifically he was interested in the ICU capacity as it applies to dealing with the more severe respiratory failure that has been reported in association with this infection. You might wonder why he called me of all people. Well, this is because I published a bunch of papers recently (that have been dutifully ignored by policy makers) that quantify the expected stress to the healthcare system in the US posed by the sky-rocketing increase in the population of patients requiring ventilators to assist them with breathing. How naïve I was to think that our numbers might be used for planning purposes, so that we could be better prepared for this growth!

A year since we first started to come out with the numbers, there are still no reliable estimates, or even attempts to derive them, as far as I can tell, of the US ICU surge capacity. And this information is more critical now than ever, as we are faced with the potential for untold numbers of H1N1-related hospitalizations accompanied by severe respiratory failure. It is shocking to me that we are leaving these infrastructure issues to chance.

But wait, why am I so shocked? This is just another byproduct of our fragmented healthcare "system". There is no one either to take or to designate responsibility for planning. While our professional organizations are doing the best they can, their approach is usually siloed and somewhat distracted: in case you have not heard, we are also tackling the most rampant pandemic of antibiotic resistant infections, which affects ICUs disproportionately.

So, who will take charge of this hot potato? The CDC? Homeland Security? FEMA (chuckle-chuckle)? Press your representatives to tackle this thorny issue, because if you are worried about planned rationing now, wait until you see what unplanned bedlam looks like. Condi Rice said that the US intelligence community just did not have the imagination necessary to anticipate the 9/11 terrorist attack. Let us not have to resurrect this tired excuse this flu season.

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